Clinical Operations Manager

Jobtailor; Deutschland; Remote; EUR 103.000 - 155.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a senior clinical operations leader to direct leave and disability certification reviews. You will oversee a team, set standards, and coordinate across Compliance, Legal, and Product to ensure audit-ready processes.

Responsibilities include building workflows, mentoring staff, and driving continuous improvements in certification review throughput and quality.

Qualifikationen

• RN license and CCM strongly preferred; URAC/NCQA experience is a plus.
• 3+ years in disability, leave-of-absence, or claims-related clinical review.
• Experience managing a care team in a leave/disability setting.
• Experience designing or standardizing operational workflows, SOPs, or training.
• Strong cross-functional collaboration with Compliance, Legal, Finance, CX, and Product.
• Ability to build a new function amid ambiguity; compliant, audit-ready documentation.
• Must be legally authorized to work in the United States and physically reside there.

Aufgaben

• Own end-to-end clinical review of medical certifications supporting leave requests.
• Apply clinical judgment to documentation sufficiency and consistency questions.
• Oversee day-to-day clinical operations, including intermittent leave analysis and extension evaluations.
• Manage the medical certification team, including hiring, coaching, and performance management.
• Serve as clinical escalation point for disputed certifications and defensible resolutions.
• Support cross-functional execution across Product, Legal, Compliance, and CX.
• Resolve operational issues and remove bottlenecks affecting throughput.
• Build and improve workflows for consistent reviewer outcomes.
• Create and update SOPs and documentation-sufficiency standards.
• Manage operational systems and reporting and maintain audit-ready trails.
• Identify certification-review trends and drive continuous workflow improvements.
• Own clinical consistency and compliance oversight; manage licensing/credentialing.
• Support compliance initiatives and coordinate insurance/regulatory requirements.
• Partner with Compliance leadership on escalated and legally sensitive cases.
• Align with department leaders on priorities and performance; review QA results.
• Set performance standards and design onboarding/training curricula.
• Plan operational improvements and roadmap for expanding clinical operations.
• Develop ongoing education for the Leave Specialist team.

Kenntnisse

FMLA knowledge

ADA knowledge

People management

Workflow design

Certified Case Manager (CCM)

Licensing & credentialing

Cross-functional collaboration

Coaching & training

Documentation standards

Quality assurance

Ausbildung

RN license

Certified Case Manager (CCM)

URAC accreditation

NCQA accreditation

Jobbeschreibung

• Own end-to-end clinical review of medical certifications supporting leave requests
• Apply clinical judgment to documentation sufficiency and consistency questions
• Oversee day-to-day clinical operations, including intermittent leave analysis and extension evaluations
• Manage the medical certification team, including hiring, coaching, and performance management
• Serve as the clinical escalation point for disputed certifications and work cases to defensible resolutions
• Support cross-functional execution across Product, Legal, Compliance, and CX
• Resolve operational issues and remove bottlenecks affecting clinical review throughput
• Build and improve workflows for consistent reviewer outcomes
• Create and update SOPs and documentation-sufficiency standards
• Manage operational systems and reporting and maintain audit-ready documentation trails
• Identify certification-review trends and translate them into continuous workflow improvements
• Own clinical consistency and compliance oversight
• Manage licensing and credentialing for the clinical team
• Support compliance initiatives and coordinate insurance and regulatory requirements
• Partner with Compliance leadership on escalated and legally sensitive cases
• Align regularly with department leaders on operational priorities and performance
• Review operational performance and quality-assurance results and run reviewer quality calibration
• Set performance standards and design onboarding and training curricula
• Plan operational improvements and own the roadmap for expanding the clinical operations function
• Develop and facilitate ongoing education for the Leave Specialist team

Requirements

• Strong knowledge of FMLA, ADA, and state paid-leave/disability laws as they apply to clinical certification standards
• 3+ years experience in disability, leave-of-absence, or claims-related clinical review
• RN license strongly preferred; significant utilization review experience within an insurance company, TPA, or leave-management environment may be considered in lieu of licensure
• Direct experience managing a care team with expertise in Short & Long-Term Disability, Family & Medical Leave Administration, and ADA Accommodations and the Interactive Process
• 3+ years of people-management experience
• Experience designing or standardizing operational workflows, SOPs, or training programs
• Strong cross-functional collaboration with Compliance, Legal, Finance, CX, and Product
• Comfortable building a new function amid ambiguity
• Certified Case Manager (CCM) or similar credential a plus
• URAC/NCQA accreditation experience a plus
• Prior experience at a leave/disability carrier or TPA a plus
• Must be legally authorized to work in the United States
• Must be physically working from within the United States

Core Competencies

Demonstrates expertise in clinical review processes, compliance oversight, and operational management within leave and disability frameworks. Proficient in managing clinical teams, developing workflows, and ensuring adherence to FMLA, ADA, and state regulations.

Highest-signal resume keywords

• Clinical Review Management
• FMLA and ADA Knowledge
• People Management Experience
• Operational Workflow Design
• Certified Case Manager (CCM)

ATS Optimization Keywords

Hard Skills

• Clinical Judgment
• Documentation Standards
• Performance Management
• Operational Systems Management
• Quality Assurance
• Licensing and Credentialing
• Continuous Workflow Improvement
• SOP Development
• Intermittent Leave Analysis
• Disability Claims Review

Soft Skills

• Cross-Functional Collaboration
• Coaching and Training
• Problem Solving
• Adaptability
• Communication

Certifications & Qualifications

• RN License
• Certified Case Manager (CCM)
• URAC Accreditation
• NCQA Accreditation

Industry Keywords

• Leave Management
• Disability Management
• Claims Review
• Compliance Initiatives
• Insurance Regulations
• Paid Leave Laws
• Interactive Process
• Short-Term Disability
• Long-Term Disability
• Leave-of-Absence